Provider Demographics
NPI:1245619907
Name:KELLER, TRACY C (LPC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:C
Last Name:KELLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:STUETTGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6980 N PORT WASHINGTON RD
Mailing Address - Street 2:STE 202
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3900
Mailing Address - Country:US
Mailing Address - Phone:414-351-7100
Mailing Address - Fax:414-247-4082
Practice Address - Street 1:6980 N PORT WASHINGTON RD
Practice Address - Street 2:STE 202
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217
Practice Address - Country:US
Practice Address - Phone:414-351-7100
Practice Address - Fax:414-247-4082
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1903-226101YM0800X
WI5702101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health